Biohazard Cleanups Not Pretty—and Neither Are the Costs to Insurers

If Peter Duncanson is on the scene, it’s probably not pretty.

It could be a CSI-like crime scene with spattered blood and skin fragments on the sofa and wall. Or a trauma scene where an injured employee or animal traipsed blood and bodily fluids around a work area. Or an apartment fouled by sewage backup.

Duncanson is a biohazard cleanup professional. He has seen it all.

“It may be mass traumas. It may be animals. You ever had a raccoon get stuck in an attic and die? That’s a biohazard,” Duncanson said.

Also, bats in the attic. “You have bat guana, bat droppings, that’s a biohazard,” he added.

Duncanson is director of business operations for ServiceMaster Restore, which provides commercial and residential disaster restoration services for floods, fires and much worse. He has been with the firm 32 years, first as a business owner for 10 years in Chicago, and then on the corporate staff ever since heading up operations and franchisee training roles in the disaster recovery part of the business.

Biohazard recovery involves cleaning of blood, body fluids and other potentially infectious material (OPIM). The claims are often associated with suicides, homicides and body decomposition and may include cases of mass trauma, industrial accidents, infectious disease contamination, even animal risks.

Duncanson was speaking at the recent Property Loss Research Bureau (PLRB) meeting in Boston before a roomful of claims professionals curious about what firms like his actually do for the money insurers pay them. As far as they are concerned, if cleanup crews like Duncanson’s are on the scene, the bills aren’t pretty either.

Yet they don’t understand why biohazard cleanup has to be so expensive.

Brian Klupper, policies and procedures manager for American Family Insurance, who has more than 30 years in the property insurance claims field, is among those who question why biohazard labor cleanup costs tend to be double or triple what a water loss or building fire cleanup might be.

Klupper spoke alongside Duncanson at the PLRB gathering.

“The fees are just unbelievable,” Klupper said, citing one estimate he received of $45,000 for cleaning one room. “I’m not sure how they get to $45,000 for cleaning one room.”

He said that while a typical water mitigation claim might cost $2,000 to $3,000 and a fire contents and building mitigation claim runs $4,000 to $8,000, biohazard cleanups can run double or triple on the labor charges.

He said insurers can work with some providers to get at a better price but “there’s some that are way out of line. That’s why I think everybody’s in this room.”

Klupper has his theories on why the costs of biohazard cleanup are so high. He believes there are three misconceptions: all biohazard situations need to be treated the same; when something is contaminated, it needs to be destroyed; and the same cleaning protocol must be followed for all types of losses.

He advised claims pros to question these misconceptions and to emphasize common sense, including the idea that most items at a trauma scene probably do not need to be destroyed or removed.

Klupper also urged the claims pros to ask biohazard firms for a work plan and a preliminary estimate for their services.

Though he questioned the costs, Klupper acknowledged that trauma claims are unlike others.

“The aftermath is usually a bad situation, a death or an injury or something like that. It’s emotional. You’re dealing with family members or you’re dealing with an apartment building owner who is very upset with this situation and it’s not a good place to be. They’re tough on the individual,” he said.

While an insurer typically has protocols for handling fire, roof, theft and other losses, it probably does not have one for biohazard claims, despite the fact that the costs are so high, according to Kupper.

Duncanson was left to explain the practices and costs of biohazard specialists.

It helped that he is also chairman of the restoration industry‘s nonprofit Institute of Inspection, Cleaning and Restoration Certification (IICRC), which has just released first-ever standards to guide technicians in the cleanup of trauma and crime scenes.

Duncanson thinks the new IICRC standards, known as S540, will shed some light on what specialists like him do and give claims professionals better idea of what to expect from their restoration providers.

“This will give you some of that expertise to say, ‘All right, I’m looking at this claim and it looks like it’s excessive based on the 540. I have these questions,'” he told the claims professionals.

Duncanson did not defend inflated bills but did stress that major hazmat operations can spread very quickly if the infected area is not isolated and otherwise not handled correctly.

Duncanson shared stories and photos to illustrate what can be involved in some biohazard scenarios. Like Klupper, he stressed the importance of technicians employing common sense and avoiding unnecessary costs, even while describing conditions and risks that might explain why some invoices are extreme.

So what do they do when they arrive on a biohazard scene?

First, nobody enters a building or scene to clean until the police have given the green light.

If a body has been involved—that is for the coroner or undertaker to handle, not the biohazard team.

Once the green light is given, the first part of the job is to assess the area of impact. What area of the space needs to be cleaned and what steps need to be taken to prevent further contamination?

Duncanson cited an example of a dead person on a bed in a bedroom.

“I’ve got to isolate the bedroom from the rest of the structure so that I don’t cross contaminate the rest of the structure. Anything that I have to bag, should be done in the bedroom so that it’s all contained,” he said.

He’s had some unpleasant jobs.

There was the case of raw sewage backing up into apartment for 30 days before his crew got the call from the city health department. The landlord had been given 24 hours to fix the problem.

“They moved everybody out of the basement apartments and we had to go in and do the cleanup,” he recalled.

Every 24 hours the landlord had to bring him another check for $5,000 until he got a plumber to fix the source of the problem because cleanup was ongoing—and there was some question whether the landlord was good for the payment.

“We were trying to stay ahead of the problem and … you can only imagine what it smells like.”

He described a CSI-like blood trauma scene, pointing to graphic photos of skull, skin tissue and hair fragments. “That’s the head, that’s the body, the feet were right there. Somebody sat down on their couch, took a shotgun and blew their head off,” he said.

There was also the case that looked like a crime scene but was actually the result of a deer that saw his reflection in a church window, jumped through the window, cutting himself and spewing blood all around as he ran throughout the rooms of the church in panic.

The blood-borne pathogens situation of a deer is not the same as with humans, according to Duncanson, but there are concerns. “We do still have to take precautions, but not nearly as severe as if it were human blood because human to human transmission is different than animal to human through the blood.”

Before he flew to Boston for the PLRB, he was in New Mexico at a summer campsite that had been closed up since last October, which meant it had been a playground for mice. There is a sign on the building, “Don’t enter until ventilated,” because of the mice droppings, which as with those from birds and bats, present the risk of the lung infection histoplasmosis.

“We have a whole protocol, opening the building, ventilating it before anyone goes in. You have to ventilate it, dry it out for awhile,” he said.

Duncanson acknowledged that his case scenarios represent extreme situations, where the cleanup is also going to require extreme measures. Yet, he pointed out, cleanup is much more than just showing up with a crew and cleaning supplies.

“How we go about the cleanup is what’s important. We have to think about not only the cleanup that we’re doing, but who’s impacted? Well, that means the family, community and even the technicians that do the job,” he said.

The cleanup for the church-going deer provided one example. “Members of the church find out about it and they come to help, or want to be a part of it. That’s still part of the community,” he recalled.

There are often also news crews. “We always we have to be cognizant of the news crews that are going to show up. Who can talk to the news? Who can talk to the media? In most cases, you don’t want anybody to talk to the media. We stay out of those things.”

There is also the potential trauma for the technicians themselves, who may need counseling after a job. Duncanson cited one veteran worker who couldn’t face anymore after the deer. “I don’t know what it was about it that got to him,” he said.

He said ServiceMaster never sends just one technician to do a trauma job. “We generally send three because they need to be able to talk to each other, decompress,” he said.

Except that in his 32 years, he’s been on a few cases by himself when they happened on holidays, a situation that perplexed his young children. “When do most suicides occur? During the holidays. I wouldn’t send my crews to go out and do a lot of that work without me. I’d go do them myself, especially the Christmas ones.”

Every biohazard material or contaminated material goes in a red bag (sometimes they are deep orange)—similar to what doctors and nurses use in hospitals. The bags are placed in special biohazard containers and then picked up to be taken to be incinerated.

Materials too big for red bags —such as bedclothes or portions of a mattress or carpet that have been bloodied—are simply gathered and labeled with red tags.

Duncanson said costs can be controlled by only removing contaminated portion of carpets, furnishings, mattresses or materials—rather than taking up an entire carpet, or cutting out a piece of wood floor, drywall or ceiling.

The cost can escalate based on the size of the area of impact, as when blood or other hazard has been spilled through many rooms. Every surface in a home may need to be disinfected.

“Can I go in and use the spray disinfectant? Can I use liquid disinfectants? Do I have to wipe things down? That depends upon the situation.”

Air quality is another concern, as in cases where there has been a decomposing dead body for days or weeks. This may require more cleaning because of flies and vermin that could transport the germs everywhere.

While special personal protective equipment (PPE) for technicians isn’t always necessary, when it is, it can be expensive.

The gear can range from simple gloves and goggles, masks and disposable gloves all the way to extreme cases needing the $80 Tyvek suits, or what Duncanson calls the full hazmat or “moon suits.” That’s in addition to technicians being equipped with respirators, extractors and red bags.

Costs also rise as personnel have to change in and out of PPE—as they go to and from a contaminated area. Thus, insurers could get invoiced for three to five PPE changes per person on a typical job.

Costs can really escalate when a job calls for setting up a decontamination chamber because the entire structure is impacted and needs to be isolated and because there may be children or nosey neighbors around. Crews must put on and take off their protective gear inside the protective chamber.

“You don’t go outside in your protective gear. You don’t want to scare the humans,” he said, seriously, noting a need to maintain a safe working environment and keep away gawkers.

A single room cleanup may only take a day, but when multiple rooms are involved cleanup could take two or three people and multiple sets of PPE for two days.

Duncanson noted that even simple blood cleanup is more complex today than it was 35 years ago. Some of that is due to the risk of HIV and AIDS. “We didn’t have precautions that we take today when we think about blood,” he said.

Once a site is contained, once the liquid, blood or other fluid is contained, then technicians can start removing a lot of their protective gear.

Everything in a red bag or tagged biohazard has to be incinerated. Firms that pick up hazardous waste typically have minimum charges starting at $300 to $500. It will cost a lot more for them to haul away a full-size bed or an entire room carpet than to take pieces of the mattress and bedclothes or carpet placed in red bags.